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3D ultrasound navigation system for screw insertion in posterior spine surgery: a phantom study

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International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose

Posterior spinal fusion surgery is required to correct severe idiopathic scoliosis. The surgery involves insertion of screws which requires high accuracy to prevent neurologic damage to the spinal cord. Although conventional CT navigation can reduce this risk, 3D-ultrasound-based navigation could achieve this without added ionizing radiation and usage of expensive and bulky equipment. This study aimed to evaluate the accuracy of a 3D ultrasound navigation system for posterior spine surgery.

Methods

A custom 3D ultrasound (3DUS) with model-to-surface registration algorithm was developed and integrated into a 3D navigation environment. A CT scan of an adolescent spine (T3-T11) was segmented and 3D printed for experiments. A probe with reflective markers was placed in vertebral pedicles 684 times in varying levels, positions in the capture space and orientation of vertebra, and the entrypoint and trajectory accuracies were measured.

Results

Among 684 probe placements in vertebral levels T3 to T11 in the phantom spine, 95.5% were within 1 mm and 5° of accuracy, with an average accuracy of 0.4 ± 0.4 mm and 2.1 ± 0.9°, requiring 8.8 s to process. Accuracies were statistically significantly affected by vertebral orientation and position in the capture volume, though this was still within the targeted accuracies of 1 mm and 5°.

Conclusion

This preliminary ultrasound-based navigation system is accurate and fast enough for guiding placement of pedicle screws into the spine in posterior fusion surgery. The current results are limited to phantom spines, and future study in animal or human cadavers is needed to investigate soft tissue effects on registration accuracy.

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Availability of data and materials

Not applicable.

Code availability

Custom code.

Abbreviations

3DUS:

3D ultrasound

AIS:

Adolescent idiopathic scoliosis

CT:

Computed tomography

ICP:

Iterative closest point

ANOVA:

Analysis of variance

NW:

Northwest

NE:

Northeast

SW:

Southwest

SE:

Southeast

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Funding

The research was funded by the Alberta Spine Foundation, the Natural Sciences and Engineering Research Council of Canada, Alberta Innovates.

Author information

Authors and Affiliations

  1. Department of Biomedical Engineering, University of Alberta, 1098 Research Transition Facility, 8308-114 Street, Edmonton, AB, T6G 2V2, Canada

    Andrew Chan & Edmond Lou

  2. Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, Edmonton, AB, T6G2G4, Canada

    Eric Parent

  3. Department of Surgery, University of Alberta, 2D, Walter C Mackenzie Health Sciences Center – 8440 – 112 Street, Edmonton, AB, T6G 2B7, Canada

    Jim Mahood & Edmond Lou

  4. Department of Electrical Engineering, University of Alberta, Donadeo ICE 11-263, 9211-116 Street, Edmonton, AB, T6G 1H9, Canada

    Edmond Lou

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  1. Andrew Chan
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Correspondence to Edmond Lou.

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Chan, A., Parent, E., Mahood, J. et al. 3D ultrasound navigation system for screw insertion in posterior spine surgery: a phantom study. Int J CARS 17, 271–281 (2022). https://doi.org/10.1007/s11548-021-02516-9

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  • DOI: https://doi.org/10.1007/s11548-021-02516-9

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